In general, lip lacerations should be closed in layers, depending on the depth of the wound In full-thickness lip lacerations, a three-layer repair is required The emergency provider should begin with the oral mucosa, using 5-0 absorbable material, followed by the orbicularis oris muscle layer to include the inner and outer fibrofatty layers, and finish with the skin, using 6-0 nonabsorbable or fastabsorbing gut, interrupted sutures Small wounds, less than cm, on the inner aspect of the lip without communication to the skin surface need not be repaired External lip wounds not communicating with the mucosal surface can be closed by either single- or double-layer closure, depending on the depth and degree of gaping of the wound Absorbable sutures (5-0) for the subcutaneous layer and either absorbable or nonabsorbable (6-0) sutures for closure of the skin can be used, depending on the ease with which they can be removed Extensive lip injuries with tissue loss or those caused by electric burns, especially those that involve the angle of the mouth, should be referred to a plastic surgeon Associated injuries such as dental trauma, mandibular fractures, and closed head injuries should be ruled out Cheek Lacerations When managing lacerations involving the cheeks, the provider must evaluate the integrity of the underlying structures The parotid gland and duct, the facial nerve, and the labial artery are in close proximity to the surface of the skin and can be injured, often as a result of an animal bite If parotid gland or duct injury is identified, consultation with a surgical specialist is advised Puncture wounds resulting from animal bites should be debrided and irrigated thoroughly Some of these puncture wounds are better off left without closure to reduce infection rate, especially if the cosmetic outcome is unlikely to be compromised Otherwise, simple interrupted 6-0 absorbable sutures can be used to close uncomplicated lacerations of the cheeks Tongue Lacerations The tongue is a vascular and muscular organ Tongue lacerations often hemorrhage excessively in the beginning, but the bleeding usually ceases quickly as the lingual muscle contracts Controversy exists surrounding the indications for closure, which is in part related to the challenge of repair given the inaccessibility of these wounds Most tongue lacerations can be left alone with good results However, large lacerations involving the free edge may heal with a notch causing dysfunction of the tongue Generally, this type of laceration should be repaired Large flaps and lacerations that continue to bleed or are likely to become contaminated with food